Fixation of the Volar Ulnar Corner in Distal Radius Fractures: A Comparative Study

The purpose of this study was to compare outcomes of distal radius fractures with a volar ulnar corner (VUC) component treated with standard volar plating or by specific VUC fixation. This study investigated outcomes, radiographic measures, and specialty-based preference associated with surgical treatment of VUC injuries using VUC-specific fixation versus nonspecific VUC fixation.

We retrospectively analyzed outcomes for 39 patients with a distal radius fracture with VUC component at a level-1 trauma center over 10 years, 2011-2021. Patients underwent either VUC-specific fixation with implants such as a volar rim plate, or with a standard volar plate. The primary outcome of this study was fixation failure and need for revision. Secondary outcomes included complication rate, radiographic alignment, and differences in fixation based on fellowship training.

Sixteen of the 39 patients studied had undergone VUC-specific fixation, with a significantly higher rate of use of VUC-specific fixation in fellowship trained hand surgeons compared with fellowship-trained trauma surgeons. There was no significant difference in loss of reduction, revision surgery, or complications. Radiographic measures were statistically similar between both groups postoperatively. Trauma trained surgeons had a significantly increased postoperative radial inclination versus hand-trained surgeons.

This study suggests that not all VUC injuries require specific VUC fixation, and we may be overtreating distal radius fractures that have a VUC component. Fellowship-trained hand surgeons are more likely to employ VUC-specific fixation methods. Additional studies are warranted to determine whether other considerations such as dynamic testing intraoperatively are worthwhile.